Tuesday, December 30, 2008

Ryan and I embarked on a daunting challenge today - hardcore pottytraining of Will. Let's just say it didn't go very well. The underpants won hands down - Will probably went through 15 pair today. And those 15 "accidents" required cleaning up on mom and dad's part. And I bet you guessed it - Will actually didn't pee in the potty at all today, even though he spent a significant amount of time on his royal thrown. Ah, the joys of parenthood.

Sorry for the lack of posts, but the holidays kept the Gridiron Goddess just as busy as everyone else. We spent five days visiting Ryan's family in California for Christmas. It was quite strange really - it's the first time we've been able to visit either of our families for Christmas in years because Ryan was usually playing and we couldn't make the trip. It was definitely bittersweet - it was great to be with family for the holidays, but it was a reminder of Ryan's current employment situation.

This past weekend marked the end of the 2008 NFL regular season. It is still hard for me to believe that Ryan didn't get picked up this year. When we got word several weeks ago that the Arena Football League was folding for the 2009 season, I panicked a bit. You see, that was Ryan's back up plan. Ryan's now faced with a serious dilemma - continue to pursue an NFL career or hang up his cleats for good. He's decided to give it a couple of months in the offseason to see if he gets any interest from any teams. If by the end of February or March he hasn't heard anything, he may be ready to throw in the towel. It will be a sad ending to a wonderful and blessed career, but let's hope we're not there yet!

Now, onto the latest on Will's insurance issues. I finally spoke with the supervisor at our insurance call center who was much more helpful and concerned than the guy Ricardo I'd spoken to. Here's where we stand. We are going to be submitting a letter from Will's ENT in Buffalo who performed both of Will's ear tube surgeries. The letter I received states that Will's recurrent ear infections are quite likely to be the cause of his delays and that he feels Will's speech therapy is medically necessary. We'll submit this letter and hope that it will suffice to provide evidence of an underlying medical condition (the recurrent ear infections) for the purpose of our appeal.

If that doesn't work, I did find out some additional information. Cigna is bound by state law mandates, and since the state of Texas mandates insurance companies pay for autism treatment for children diagnosed on the spectrum, they would be bound to pay. According to the supervisor, the NFL also complies with and recognizes state mandates. If we have to get Will officially diagnosed to get his services paid for, then so be it. Problem is, once that diagnosis is made, it will follow him for the rest of his life and that will certainly lead to all sorts of issues down the road.

So we'll see - there's some hope that we have what we need to get Will's services paid for. I'll keep you posted.

Monday, December 22, 2008

Something miraculous happened the other day - I got Will and Bryn in a picture at the same time. Granted, little mama was snug tight in her Bumbo and I had to quickly snap Will on the counter next to her, but success nonetheless. Enjoy the holiday fun!

Tuesday, December 16, 2008

It was COLD in Texas today - like, Buffalo cold. It was in the 20s and we had snow flurries. Since Texas schools can't handle that weather, class was cancelled. I worked today and when I got him this afternoon, Will brought me his shoes and handed me my car keys signaling to me that it was time to go. I'm not sure if he wanted to go somewhere in particular, but he wanted to get out of the house! LOL. It was very sweet. So he and Ryan took a trip to the store.

An insurance update - Cigna is tripping me out. I called today to ask how long we had to file our appeal. The rep I spoke with said she had called the claim representative asking them to put a hold on the appeal we'd already authorized. HOLD UP - we hadn't officially authorized an appeal. I literally hung up with her and called Ryan and had him fax a letter to the insurance company saying that we had not authorized an appeal and that we would be filing an official appeal when we are ready. This company is just SHADY!!!! Now they are ignoring procedural safeguards that are in place. My next step is to find out who I can contact at the NFL to discuss some of the issues we're having with the insurance company!

A rep from the insurance company called back yesterday (finally). She confirmed that Cigna does not provide coverage for services for children diagnosed on the autism spectrum. With my lawyer hat on, I mentioned that state law in Texas mandates insurance companies to cover autism treatment. She said she would look into it. I also mentioned that autism is considered a disability under federal law, and I wondered if denying coverage might result in some sort of federal discrimination lawsuit. Just some questions I threw out there for her. She said she'd check into that as well. We are officially appealing the denial so I've got to get all of my "evidence" together to submit. What a hassle, but I'm going to keep fighting, not just for Will, but for all kids with similar issues.

Saturday, December 13, 2008

I had another long and frustrating call with the insurance company yesterday regarding Will's speech therapy. After going back and forth again with the incompetent representative who called autism a "procedure" and went on to call Will's therapy "cosmetic," I came to some frightening and disheartening realizations. At one point, I'd asked to speak to the supervisor. While I was on hold for over five minutes, I had an opportunity to re-read my insurance plan's position on speech therapy coverage. After reading the following section, I had an epiphany - our insurance company has EXPLICIT exclusions for covering things like speech and occupational therapy if a child is diagnosed with autism. Here is the paragraph:

Speech therapy is generally not appropriate for use in prelingual children when there is no identified underlying medical condition or there is no possibility of the child reaching an age-appropriate level of speech (e.g. autism, pervasive developmental disorders developmental delay or mental retardation; the inability to construct sentences, stuttering or tongue thrust).

This made me look at Cigna's autism coverage. In a nutshell, it appears Cigna considers proven autism treatments such as speech and occupational therapy to be educational, not medical, in nature and will therefore not cover any of the treatments once a diagnosis is in place. Here's the kicker - our insurance company will pay the $1,000 to have a child evaluated for autism, but once that child is evaluated and is given a diagnosis, it appears Cigna has grounds to deny coverage. There is something wrong with that.

Now I really needed some clarification so I continued to hold for the supervisor who never got on the phone. I was told she was busy with conference calls, yet she apparently had enough time to point out something in a manual for the still incompetent representative to explain to me. The rep finally put me into her voicemail where I left a very focused message that I need an answer to - If my child is diagnosed with autism, will Cigna cover his speech therapy? The supervisor never returned my call.

As I'm sure you can imagine, I was devastated when I got off of the phone. I called Ryan sobbing and told him what I'd figured out. No offense to Frisco ISD and the program Will is in now, but in our opinion the school district simply doesn't provide the intense therapy and focused attention Will needs right now. If we hope to have him mainstreamed in a year or two for kindergarten, he needs more than what the school district is supplying him. I'm afraid that if we don't continue to provide these services for Will, we'll fail to maximize his potential. We're now considering private school that we can't necessarily afford, but will do what we have to do for Will.

This isn't over - we'll keep fighting. But yesterday's round went to the insurance company.

Thursday, December 11, 2008

Today was the day we decided to take the kids to see Santa. We went to a mall in Plano where they have a huge Polar Express snow globe exhibit. We decided to eat first - big mistake. You see, Santa goes on his dinner break from 5-6 p.m. Had we gone to visit Santa before dinner, maybe things would've gone more smoothly. But nope - we had to eat and so did Santa, so when we showed up at 5:15 for pictures, we quickly realized we'd need to wait. And wait we did.

We finally reached Santa around 6:45. Bryn had already puked on her shirt, so we quickly changed her. She usually goes to bed around 7, so she started getting cranky. When she cried, Will cried. We were on the verge of all hell breaking loose. Ryan and I came to a meeting of the minds that we wouldn't force Will into the picture. Sure enough, he decided he wanted nothing to do with Santa. Bryn wasn't too sure at first, but we finally got a small. We finished off our family Santa trip with a picture in front of the Polar Express.

Friday, December 5, 2008

I finally managed to secure acting representation here in Texas! Woo! I signed with the Horne Agency last week. I've already had a go-see for Neiman Marcus and have booked my first commercial (it's extra work, but hey, I've got to start somewhere). Hopefully some great assignments will come in soon!

I spoke with a Cigna representative today. Their official stance is that Will's speech therapy is not covered because there is no underlying "medical condition" that necessitates the therapy. I explain to him that Will has been labeled as developmentally delayed since he was 19-months-old. Well, Cigna doesn't consider developmental delays medical conditions because, and I quote, "everyone develops differently." O-kay. So I explain that my 4-year-old is talking at or below the level of a 2-year-old. Nothing. I start asking what medical conditions would qualify Will for services and he pretty much refused to give me this information. He said a therapist or doctor would be able to tell me what underlying medical condition is causing Will's delays. This went on and on, back and forth for about 45 minutes. We agreed that I would send in Will's speech therapy evaluations that he's received over the past few years. We'll see what Cigna chooses to do with them. But I still think we're gearing up for a fight on this one. I'll keep you posted!

Thursday, December 4, 2008

Our mailman is a slacker. He looks like he's 16 and a total smoker. We're lucky if he arrives by 5 p.m. - often times, like today, he delivers our mail after dark. This can cause problems like it has this evening. You see, in today's mail was an explanation of benefits (EOB) from our insurance company DENYING coverage for Will's speech and occupational therapy he's been receiving since June. According to the EOB, these services aren't "medically necessary" and since our insurance only covers things that are "medically necessary," they won't cover the services.

This is interesting. Back in June, I called our insurance company to see if things like speech and occupational therapy are covered under our policy. I was informed that they are as long as we have a doctor's referral. Well, we have one of those, so I'm not sure what the problem is. Even more interesting is the fact that they had previously approved coverage according to early EOBs, so why now are they denying coverage? I'm guessing it's because some pencil-pusher that the insurance company pays six figures to annual to review files and deny coverage finally came upon ours and decided that Will doesn't medically need speech and occupational therapy. Of course, this is just a guess because I can't actually find out what's going on because our mail was delivered so late and it's too late to call! Actually, it's probably a good thing because I'm emotional, and emotions and insurance companies don't mix. I'm going to have to put on my mommy/lawyer hat tomorrow morning when I make the call.

Let Cigna deny coverage for these services. I will write to every news outlet I can think of to tell our story. I think it's a captivating one - NFL player's 4-year-old son denied treatment. Hm. I bet I can find some interested parties in this story.

On a good note, I have some Will-isms for the day. Will was looking at a book this morning and grabbed Ryan's finger and pointed at an exclamation point and asked what it was. He literally said, "What is this?" He asked the same question about a question mark. I guess he recognized all the letters on the page but not the punctuation.

Even cooler - Will and I were playing this afternoon. I put my hand on my hips because I was tired of chasing him around. He put his hands on his hips. I put my arms down at my side - so did he. He was actually copying my movements. I was able to get him to do it again this evening - he even copied when I did spirit fingers! Ryan wasn't too happy about that and I promised I wouldn't make Will do that again! :)

It would just be devastating if we had to stop his services because our insurance company won't cover them. We aren't rich - nowhere close. We would not be able to afford to continue Will's services. So please send us some good vibes - I'm gearing up for a fight!